Patrick Mahomes Played Super Bowl LV with Turf Toe. What the heck is Turf Toe?

Patrick Mahomes - quarterback for Kansas City Chiefs - recovering from turf toe

The initial storyline that emanated out of the Tampa Bay Buccaneers’ victory over the Kansas City Chiefs in the NFL’s most recent Super Bowl was: “Old pro (Tom Brady) teaches young pup (Patrick Mahomes) a lesson.”
As post-game analyses of the game developed, a competing narrative emerged: “Game youngster (Patrick Mahomes) courageously fights through crippling injury.”

A primary attribute of Mahomes’ game is his ability to “scramble,” i.e., run around until he can locate an open receiver. As the Super Bowl progressed, it became obvious that Mahomes’ scrambling ability was nowhere near 100%. He was clearly hobbled by an injury to his left foot.

Examinations after the game showed that Mahomes suffered from turf toe–that’s the common name for a sprain of the ligaments surrounding the metatarsophalangeal (MTP) joint. The MTP connects the big toe to the first metatarsal, the long bone that extends from the ankle down to the toe.

This injury is commonly seen in athletes who play on artificial turf – hence the name “turf toe”. Although it is most often observed in football players, turf toe can be incurred in any sport that requires strenuous contact between an athlete’s big toe and the playing surface.

Anatomy of a turf toe

Optimal function of the MTP joint is essential for high-performance sports. It allows athletes to push off, cut, and swerve during running or jumping activities. Any compromise in the MTP joint can result in reduced explosiveness and greatly diminished performance.

The bones of the MTP joint consist of the proximal phalanx, the first metatarsal, and the tibial and fibular sesamoids.

Ligaments are strong straps of a fibrous material known as collagen. Several ligaments contribute to stabilizing the MTP joint. They wrap around the sides and bottom of the MTP joint, and they also connect the MTP joint to the first metatarsal bone.

The sesamoid bones lie just above the plantar plate ligament, the one at the bottom of the MTP joint. The sesamoids are located within an adjacent tendon. The sesamoids act as a fulcrum within the MTP joint. Their leverage provides additional strength to a muscle/tendon grouping as it flexes the toe.

Several muscles in the foot (flexor halluxis brevis, abductor hallucis brevis, and adductor hallucis brevis) surround the MTP joint and provide further stability.

In turf toe injuries, the plantar plate is often the damaged component. However, harm to the medial and lateral collateral ligaments, as well as the sesamoid bones, can also contribute to a turf toe injury.

What causes turf toe

Patrick Mahomes II - quarterback for Kansas City Chiefs - recovering from turf toe

A turf toe injury is the result of a forceful, severe over-flexion of the MTP joint. It often occurs when athletes are attempting to suddenly propel themselves forward. Strong force is exerted on an immobile foot, with the ankle straightened and the big toe flexed up. The consequent force causes a hyperextended big toe to strain the plantar plate ligament, the ligament on the bottom of the MTP joint.

Artificial turf, when compared to a natural grass surface, has a higher coefficient of friction. This means an athlete’s foot is more likely to be immobilized when in contact with turf than when in contact with natural grass.

That’s why artificial turf increases the likelihood of overwhelming force being exerted downward on a fixed MTP joint, spraining one or more of the ligaments surrounding it.

Athletes that wear flexible cleats are more at risk of turf toe injury than athletes who wear a cleat with a rigid or stiff forefoot. A shoe with a flexible forefoot places more force on the MTP joint during exertion, placing it at greater risk of turf toe-causing ligament damage.

Turf toe treatment

After taking a history of the circumstances surrounding the injury, examination of the MTP joint involves testing for pain in various structures of the joint. These structures include the plantar plate ligament, the collateral ligaments of the joint, and the sesamoid apparatus.

Range of motion is tested to determine the stability of the joint, reveal any mechanical blocks, and test for hypermobility of the joint.

X-rays are useful in identifying any bone fractures that may have been sustained. Specifically, stress x-rays—taken while the joint is stressed in various positions—evaluate if the ligaments have been compromised.

X-ray imaging can also detect harm to the sesamoid bones. An injury to, or positional shift in, the sesamoids can indicate a more serious injury that may require surgery. An MRI can evaluate the degree of injury to the ligaments, as well as reveal any cartilage injury that may have occurred to the MTP joint.

Turf toe recovery

Most turf toe injuries are conservatively treated, at least initially. The foot can be immobilized in a cast or walking boot. Treatment may employ the RICE acronym (rest, ice, compression, and elevation). Anti-inflammatory medications help lessen pain and swelling.

After 1-3 weeks of immobilization (depending on severity of the injury), gradual range of motion and physical therapy are introduced. Footwear modifications and/or various taping techniques may be used to slowly return the damaged area to full activity.

Turf toe surgery

Surgery is usually unnecessary for turf toe injuries unless there is persistent instability, pain, or weakness. However, surgery may also be indicated if there was damage or a positional shift to the sesamoid apparatus, cartilage injury, or traumatic bony deformity.

Mahomes to make a full recovery from turf toe surgery

Turf toe can cause significant disability, depending on which structures are damaged and how extensive the damage is. It is important to have a turf toe injury evaluated and treated by a foot specialist. If not properly treated, patients can develop long-lasting, or even permanent, stiffness, arthritis, or weakness in the joint.

Incidentally, Patrick Mahomes’ surgical procedure went exactly as planned. He is expected to make a full recovery during the offseason, and then make a strong run for participation in Super Bowl LVI.

Why choose University Foot and Ankle Institute for your foot and ankle care?

If you are experiencing foot or ankle pain, we’re always here to help. At UFAI, our mission is to provide the best treatments available. We want our patients to be pain-free and back to their daily activities as soon as possible.

Our nationally recognized, board-certified Doctors of Podiatric Medicine (DPMs) offer the most advanced care and the highest success rates in the nation. Our foot surgeons are leaders in developing surgical techniques and technologies that improve every patients’ podiatric experience.

We realize our patients lead busy lives. That’s why some of our podiatry clinics include their own MRIs, CAT scanners, and x-ray machines to facilitate prompt diagnosis with minimal inconvenience. Plus, several of our clinics have in-house physical therapy facilities, giving (1) our therapists immediate access to our doctors and (2) our doctors the ability to closely monitor their patients’ progress.

For more information, or to schedule a consultation, please call (877) 736-6001 or make an appointment online now.

At UFAI, we take our patients’ safety seriously. Our clinics’ and surgery centers’ Covid-19 patient safety procedures exceed all CDC recommendations during this pandemic. Masks are required in our institutes at all times.

We are conveniently located throughout Southern California and the Los Angeles area. Our doctors are available at locations in or near: Santa Monica (on Wilshire Blvd.), Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California.

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